Provider Demographics
NPI:1417920430
Name:ANDERSEN, RICHARD D (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:ANDERSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2910 CENTRE POINTE DR
Mailing Address - Street 2:35-121A CHILDRENS HEALTH CARE
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113
Mailing Address - Country:US
Mailing Address - Phone:651-855-2327
Mailing Address - Fax:651-855-2310
Practice Address - Street 1:347 N SMITH AVE
Practice Address - Street 2:CHILDRENS SPECIALTY CLINIC INFECTIOUS DISEASES STPL
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-220-6444
Practice Address - Fax:651-220-7233
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2025-09-11
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Provider Licenses
StateLicense IDTaxonomies
MN23462208000000X, 2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
A02032Medicare UPIN